Cataracts Research: 2002-2006
     
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003169.
Multifocal versus monofocal intraocular lenses after cataract extraction.
Leyland M, Pringle E.
Frimley Park NHS Trust, Department of Ophthalmology, Portsmouth Road, Frimley, Surrey, UK.

BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision however still requires additional refractive power usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES: The objective of this review was to assess the effects of multifocal IOLs, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which includes the Eyes and Vision Group Trials Register) on The Cochrane Library (2006, Issue 3), MEDLINE (1966 to July 2006), EMBASE (1980 to July 2006), NRR (2006, Issue 3) and PUBMED searched on 25 July 2006, limit: 90 days (entry date). We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal intraocular lenses for information about additional published and unpublished studies. SELECTION CRITERIA: All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. DATA COLLECTION AND ANALYSIS: Data were collected and trial quality was assessed. Where possible, statistical summary measures were calculated otherwise data were tabulated. MAIN RESULTS: Ten trials were identified, and a further three are pending review. There was significant variability between the trials in which outcomes were reported. Unaided distance acuity was similar in multifocal and monofocal IOLs (standardised mean difference (SMD) 0.03, 95% Confidence Interval (CI) -0.13 to 0.19). There was no statistical difference between multifocal IOLs and monofocals with respect to the proportion of participants achieving 6/6 best corrected visual acuity (Peto odds ratio (OR) 1.05, 95% CI 0.67 to 1.63). Unaided near vision was improved with the multifocal IOLs. Total freedom from use of glasses was achieved more frequently with multifocal than monofocal IOLs (OR for spectacle dependence 0.17, 95% CI 0.12 to 0.24). Adverse effects included reduced contrast sensitivity and the subjective experience of haloes around lights. AUTHORS' CONCLUSIONS: Multifocal IOLs are effective at improving near vision relative to monofocal IOLs. Whether that improvement outweighs the adverse effects of multifocal IOLs will vary between patients. Motivation to achieve spectacle independence is likely to be the deciding factor.

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Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001323.
Surgical interventions for age-related cataract.
Riaz Y, Mehta JS, Wormald R, Evans JR, Foster A, Ravilla T, Snellingen T.
Moorfields Eye Hospital, City Road, London, UK. yasmin.riaz@gmail.com

BACKGROUND: Cataract accounts for 50% of blindness globally and remains the leading cause of visual impairment in all regions of the world, despite improvements in surgical outcomes (WHO 2005). This number is expected to rise due to an aging population and increase in life expectancy. Although cataracts are not preventable, their surgical treatment is one of the most cost-effective interventions in healthcare. OBJECTIVES: To compare the effects of different surgical interventions for age-related cataract. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE up to July 2006, NRR Issue 3 2005, the reference lists of identified trials and we contacted investigators and experts in the field for details of published and unpublished trials. SELECTION CRITERIA: We included randomised controlled trials (RCTS). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and discrepancies were resolved by discussion. Where appropriate, risk ratios, odds ratios and weighted mean differences were summarised after assessing heterogeneity between the studies. MAIN RESULTS: We identified 17 trials that randomised a total of 9627 people. Phacoemulsification gave a better visual outcome than extracapsular surgery but similar average cost per procedure in Europe but not in poorer countries. Extracapsular surgery with posterior chamber lens implant and ICCE with or without an anterior chamber intraocular lens (IOL) implant gave acceptable visual outcomes but extracapsular surgery had less complications. Manual small incision surgery provides better visual outcome than ECCE but slightly inferior unaided visual acuity compared to phacoemulsification. AUTHORS' CONCLUSIONS: This review provides evidence from seven RCTs that phacoemulsification gives a better outcome than ECCE with sutures. We also found evidence that ECCE with a posterior chamber lens implant provides better visual outcome than ICCE with aphakic glasses. The long term effect of posterior capsular opacification (PCO) needs to be assessed in larger populations. The data also suggests that ICCE with an anterior chamber lens implant is an effective alternative to ICCE with aphakic glasses, with similar safety. Phacoemulsification provides the best visual outcomes but will only be accessible to the poorer countries if the cost of phacoemulsification and foldable IOLs decrease. Manual small incision cataract surgery provides early visual rehabilitation and comparable visual outcome to PHACO. It has better visual outcomes than ECCE and can be used in any clinic that is currently carrying out ECCE with IOL. Further research from developing regions are needed to compare the cost and longer term outcomes of these procedures e.g. PCO and corneal endothelial cell damage.

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J Cataract Refract Surg. 2006 Oct;32(10):1672-7.
Primary intraocular lens implantation in infants: complications and visual results.
Lundvall A, Zetterstrom C.
St Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. anna.lundvall@sankterik.se

PURPOSE: To evaluate the complications and visual results in a consecutive series of patients having cataract extraction with intraocular lens (IOL) implantation in the first year of life. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This retrospective study comprised 28 children (31 eyes) who had cataract surgery with primary IOL implantation. RESULTS: The median age at surgery was 2.5 months (range 8 days to 10 months). The median follow-up was 36 months. Two newborns with persistent fetal vasculature (PFV) who had surgery at 8 days and 17 days, respectively, developed intraoperative vitreous hemorrhage; a retinal detachment developed in 1 of the eyes. Intraocular lens luxation occurred in 2 infants with PFV. Seventy percent of eyes developed opacification of the visual axis that required additional surgery. Chronic glaucoma developed in 2 eyes and transitory glaucoma in 1 eye. Two of the glaucoma cases occurred in eyes with PFV. In 7 eyes of 4 infants with bilateral cataract, the median visual acuity was 20/63 (range 20/25 to 20/100). In 12 infants with unilateral cataract without PFV, 7 achieved a visual acuity between 20/32 and 20/200 (median 20/63), 4 achieved counting fingers (CF), and 1 achieved light perception. In 12 eyes with PFV, 2 achieved a visual acuity of 20/200 and the rest achieved CF or worse. CONCLUSIONS: After-cataract with membrane formation was the main complication in infants with primary IOL implantation. The glaucoma incidence was low at the last follow-up.

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J Cataract Refract Surg. 2006 Oct;32(10):1632-7.
One-year follow-up of bag-in-the-lens intraocular lens implantation in 60 eyes.
De Groot V, Leysen I, Neuhann T, Gobin L, Tassignon MJ.
Department of Ophthalmology, University of Antwerp, Edegem, Belgium. veva.de.groot@uza.be

PURPOSE: To report the feasibility and clinical results of implanting a bag-in-the-lens intraocular lens (IOL) designed to prevent posterior capsule opacification after cataract surgery. SETTING: Departments of Ophthalmology, University of Antwerp, Antwerp, Belgium, and University of Munich, Munich, Germany. METHODS: This prospective study comprised 63 eyes (55 patients; 7 children, 48 adults) scheduled for cataract surgery and bag-in-the-lens IOL implantation. A posterior curvilinear capsulorhexis the same size as the anterior capsulorhexis was created for IOL insertion. After surgery, lens epithelial cell (LEC) proliferation was documented every 6 months with a minimum follow-up of 12 months. RESULTS: Sixty of 63 eyes (95%) had implantation of the bag-in-the-lens IOL. Conversion to a conventional IOL was necessary in 2 cases. In 1 eye, postoperative luxation of the IOL into the vitreous occurred as a result of an oversized anterior and posterior capsulorhexis. Three eyes had early postoperative iris incarceration in the lens groove that required surgery. No LEC proliferation on the optic occurred during a mean follow-up of 22.7 months (range 12 to 64 months); LEC proliferation was confined to the peripheral capsular bag. CONCLUSION: Lens epithelial cell proliferation was mild and confined to the periphery of the capsular bag during follow-up, and the bag-in-the-lens IOL optic remained clear.

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J Cataract Refract Surg. 2006 Oct;32(10):1627-31.
Posterior capsule opacification after implantation of a hydrophilic or a hydrophobic acrylic intraocular lens: one-year follow-up.
Kugelberg M, Wejde G, Jayaram H, Zetterstrom C.
St Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. m.kugelberg@sankterik.se

PURPOSE: To evaluate the effect of hydrophilic and hydrophobic single-piece acrylic intraocular lenses (IOLs) on posterior capsule opacification (PCO) after cataract surgery. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: In a prospective study, 120 patients having cataract surgery were randomized to implantation of a hydrophilic acrylic IOL (BL27, Bausch & Lomb) or a hydrophobic acrylic IOL (AcrySof SA60AT, Alcon). Surgery was performed according to a standardized protocol by 1 of 3 surgeons. Best corrected visual acuity, contrast sensitivity, glare, intraocular pressure, and flare were measured 1 week, 3 months, and 1 year after surgery. Posterior capsule opacification was assessed by digital retroillumination photography and analysis using POCOman software at 1 year. The rate of neodymium:YAG (Nd:YAG) capsulotomy for each IOL was also recorded. RESULTS: At 1 year, the hydrophilic acrylic IOL group had a significantly greater percentage area and severity of PCO than the hydrophobic acrylic IOL group (P<.001). Two patients in the hydrophilic acrylic IOL group and 4 in the hydrophobic acrylic IOL group had an Nd:YAG capsulotomy within the first year (P>.05). Contrast sensitivity was significantly better in the hydrophilic acrylic group at 3 months (P<.05); however, at 12 months no difference between the IOLs was observed. There was no significant difference in the other measured parameters. CONCLUSION: Patients with the hydrophilic acrylic BL27 IOL had a significantly greater percentage area and severity of PCO than those with the hydrophobic acrylic SA60AT IOL 1 year after surgery.

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Saudi Med J. 2006 Sep;27(9):1296-301.
A Cochrane Systematic Review finds no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery.
Fedorowicz Z, Lawrence DJ, Gutierrez P.
UK Cochrane Centre, UK. zbysfedo@batelco.com.bh

This review was conducted to determine reliable evidence regarding the safety, feasibility, effectiveness, and cost-effectiveness of cataract extraction performed as a day care versus in-patient procedure. The search to identify randomized controlled trials comparing day care and in-patient surgery for age-related cataract included the Cochrane Eyes and Vision Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS Latin American and Caribbean Literature on Health Sciences. Assessment of methodological quality was based on criteria defined by the Cochrane Collaboration. The primary outcome was the achievement of a satisfactory visual acuity 6 weeks after operation. Two trials, involving a total of 1284 people, are included. One trial reported statistically significant differences in early postoperative complication rates in the day care group, which had no clinical relevance to visual outcomes 4 months postoperatively. Mean change in visual acuity Snellen lines of the operated eye 4 months postoperatively was 4.1 standard deviation SD 2.3 for the day care group and 4.1 SD 2.2 for the in-patient group. Costs were 20% more for the in-patient group attributable to higher costs for overnight stay.

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J Cataract Refract Surg. 2006 Sep;32(9):1513-20.
Effect of anterior capsule polishing on the posterior capsule opacification-inhibiting properties of a sharp-edged, 3-piece, silicone intraocular lens: three- and 5-year results of a randomized trial.
Bolz M, Menapace R, Findl O, Sacu S, Buehl W, Wirtitsch M, Leydolt C, Kriechbaum K.
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

PURPOSE: To evaluate the long-term effects of anterior capsule polishing on regeneratory posterior capsule opacification (PCO), anterior capsule opacification (ACO), and fibrotic PCO with a silicone intraocular lens (IOL) with sharp optic edges. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This prospective bilateral randomized patient- and examiner-masked clinical trial comprised 130 eyes of 65 patients with bilateral age-related cataract. All eyes had implantation of a 3-piece silicone IOL with a truncated, sharp-edged optic (CeeOn Edge 911A, Advanced Medical Optics). In 1 eye, the anterior capsule was extensively polished using an aspiration curette after phacoemulsification and cortex aspiration. Regenerative PCO was quantified objectively, while ACO and fibrotic PCO were graded subjectively 1, 2, 3, and 5 years postoperatively. RESULTS: The mean ACO score was significantly lower in the eyes in which the anterior capsule had been polished (1 year, P<.02; 2 years, P<.03; 3 years, P<.01; 5 years, P<.01). The mean difference in regeneratory PCO and fibrotic PCO scores between the 2 groups was not statistically significant. CONCLUSIONS: Three years after cataract surgery, eyes in which the anterior capsule had been polished had significantly less ACO. However, polishing did not lower PCO intensity when a sharp-edged CeeOn 911A IOL was implanted in the bag. Although results indicate that anterior capsule polishing may enhance the development of regeneratory PCO, this trend did not reach statistical significance.

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Ophthalmology. 2006 Aug 24; [Epub ahead of print]
Cataract Surgery and the 10-Year Incidence of Age-Related Maculopathy The Blue Mountains Eye Study.
Cugati S, Mitchell P, Rochtchina E, Tan AG, Smith W, Wang JJ.
Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, Australia.

PURPOSE: To assess the long-term (10-year) risk of late age-related maculopathy (ARM) in eyes that had previously undergone cataract surgery (before the baseline examination). DESIGN: Population-based cohort study. PARTICIPANTS: In the Blue Mountains Eye Study (BMES) cohort, 2335 of 3654 baseline participants >/=49 years old (75% of survivors) were reexamined after 5 years and 1952 (76% of survivors) were reexamined after 10 years. METHODS: At the baseline examination, nonphakic (aphakic or pseudophakic) eyes were identified at slit-lamp examination and confirmed at lens photographic grading. Side-by-side grading of baseline and follow-up stereoretinal photographs was performed using the Wisconsin ARM grading system. Eye-specific data were analyzed using Kaplan-Meier estimates and generalized estimating equation models, adjusting for correlation between the 2 eyes. MAIN OUTCOME MEASURES: Incident late ARM was defined if either neovascular ARM or geographic atrophy developed in eyes without either lesion at baseline. RESULTS: After excluding eyes with either late ARM lesion at baseline or that had missing photographs at either examination, 4763 eyes were considered at risk of incident late ARM, including 132 eyes that had cataract surgery before the baseline examination. Late ARM developed in 10 of 132 nonphakic eyes (7.6%) compared to 96 of 4631 phakic eyes (2.1%). After adjusting for baseline age, gender, smoking, and presence of early ARM lesions, nonphakic (cataract surgical) eyes had a 3-fold risk of developing late-stage ARM (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.1-9.9) or neovascular ARM (OR, 3.4; 95% CI, 1.1-10.9) compared to phakic eyes. CONCLUSIONS: Our findings support the hypothesis that the long-term risk of developing late ARM is higher in cataract surgical eyes, consistent with findings from the Beaver Dam Eye Study.

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Cochrane Database Syst Rev. 2006 Jul 19;3:CD003171.
Surgical interventions for bilateral congenital cataract.
Long V, Chen S, Hatt S.

BACKGROUND: Congenital cataracts are opacities of the lens in one or both eyes of children that cause a reduction in vision severe enough to require surgery. Cataract is the largest treatable cause of visual loss in childhood. Paediatric cataracts provide different challenges to those in adults. Intense inflammation, amblyopia and posterior capsule opacification can affect results of treatment. Two treatments commonly considered for congenital cataract are lensectomy and lens aspiration. OBJECTIVES: The objective of this review was to assess the effects of surgical treatments for bilateral symmetrical congenital cataracts. Success was measured according to the vision attained and occurrence of adverse events. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochane Library, which contains the Cochrane Eyes and Vision Group Trials Register (2005, Issue 2), MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005, week 27), LILACS (6 July 2005), the Science Citation Index and the reference list of the included studies. We also contacted trial investigators and experts in the field for details of further studies. SELECTION CRITERIA: We included all prospective, randomised controlled trials that compared one type of cataract surgery to another, or to no surgery, in children with bilateral congenital cataracts aged 15 years or younger. DATA COLLECTION AND ANALYSIS: Two authors extracted data. No meta-analysis was performed. MAIN RESULTS: Four trials met the inclusion criteria. All trials were concerned with reducing the development of visual axis opacification (VAO). This was achieved with techniques that included an anterior vitrectomy or optic capture. Posterior capsulotomy alone was inadequate except in older children. AUTHORS' CONCLUSIONS: Evidence exists for the care of children with congenital or developmental bilateral cataracts to reduce the occurrence of visual axis opacification. Further randomised trials are required to inform modern practice about other concerns including the timing of surgery, age for implantation of an intraocular lens and development of long-term complications such as glaucoma and retinal detachment.

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Klin Monatsbl Augenheilkd. 2006 Jul;223(7):559-67.
[Pharmacological means to prevent secondary cataract.]
[Article in German]
Rabsilber TM, Auffarth GU.
Univ.-Augenklinik, Ruprecht-Karls-Universitat Heidelberg.

Secondary cataract or posterior capsule opacification (PCO) is still the most frequent long-term complication of cataract surgery. Tremendous advances have been made, especially during the last 10 to 15 years, in terms of surgical techniques and improvement of implant technology. However, the problem of proliferation and migration of lens epithelial cells (LECs) postoperatively has not yet been solved completely although we know that a sharp optic edge of intraocular lenses (IOL) combined with hydrodissection, complete overlapping of capsulorhexis and IOL-optic as well as capsular bending reduce PCO formation significantly. In the 1980 s, investigators like Hartmann et al. began with the application of pharmacological substances in-vitro in order to successfully prevent LECs from proliferating and migrating. Cytostatic drugs, steroids, non-steroidal antiphlogistics, adhesion inhibitors, heparin, lidocaine, suramin, immunotoxins, photodynamic therapy and osmotic effective solutions were tested. In several studies different drug delivery systems were investigated in order to provide a longer and more effective impact on LECs. However, the in-vivo use has been viewed critically since the selective targeting of LECs was not possible and serious damage to the surrounding tissue had to be considered. Recently, the development of the PerfectCapsule System for vacuum-sealed capsule irrigation allows the selective targeting of LECs inside the capsular bag. This survey gives an update on past, current and future means and trends to reduce or prevent PCO formation pharmacologically.

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Br J Ophthalmol. 2006 Jul 19; [Epub ahead of print]
The international intravitreal bevacizumab safety survey: Using the internet to assess drug safety worldwide.
Fung AE, Rosenfeld PJ, Reichel E.
Pacific Eye Associates, United States.

PURPOSE: Off-label intravitreal injections of bevacizumab (Avastin) have been performed for the treatment of neovascular and exudative ocular diseases since May 2005. Since then, the use of intravitreal bevacizumab has spread worldwide, but the drug-related adverse events (AEs) associated with its use have only been reported in a few retrospective reviews. The International Intravitreal Bevacizumab Survey was initiated to gather timely information regarding adverse events from physicians around the world via the internet. METHODS: An internet based survey was designed to identify adverse events (AEs) associated with intravitreal bevacizumab therapy. The survey web address was disseminated to the international vitreoretinal community via email. Rates of AEs were calculated from participant responses. RESULTS: Seventy centers from 12 countries reported on 7,113 injections performed on 5,228 patients. Physician-reported AEs included corneal abrasion, lens Injury, endophthalmitis, retinal detachment, inflammation / uveitis, cataract progression, acute vision loss, central retinal artery occlusion, subretinal haemorrhage, retinal pigment epithelium tears, blood pressure elevation, transient ischemic attack, cerebrovascular accident and death. None of the AE rates exceeded 0.21%. CONCLUSION: Intravitreal bevacizumab is being used globally for ocular diseases. Self-reporting of adverse events following intravitreal bevacizumab injections did not reveal an increased rate of potential drug-related ocular or systemic events. These short-term results suggest that intravitreal bevacizumab appears safe.

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Br J Ophthalmol. 2006 Jul 6; [Epub ahead of print]
Bilateral cataract surgery and driving performance.
Wood JM, Carberry TP.
Queensland University of Technology, Australia.

BACKGROUND/AIMS: Cataract surgery is one of the most common medical procedures undertaken world-wide. This study aimed to investigate whether cataract surgery can improve driving performance and whether this can be predicted by changes in visual function. METHODS: Twenty nine older participants with bilateral cataracts and eighteen control participants with normal vision were tested. All were licensed drivers. Driving and vision performance were measured prior to cataract surgery and after second eye surgery for the cataract participants and on two separate occasions for the controls. Driving performance was assessed on a closed-road circuit. visual acuity, contrast sensitivity, glare sensitivity and kinetic visual fields were measured at each test session. RESULTS: The cataract participants had significantly poorer driving performance at the first visit compared to the control participants for a range of measures of driving performance, which significantly improved to the level of the control participants following extraction of both cataracts. The change in contrast sensitivity following surgery was the best predictor of the improvements in driving performance in the cataract participants. CONCLUSIONS: Cataract surgery results in significant improvements in driving performance and these improvements are related to concurrent improvements in contrast sensitivity.

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Eye. 2006 Jun 9; [Epub ahead of print]
Comparison of epilenticular IOL implantation vs technique of anterior and primary posterior capsulorhexis with anterior vitrectomy in paediatric cataract surgery.
Rastogi A, Monga S, Khurana C, Anand K.
Pediatric Ophthalmology Service, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.

PurposeTo compare the functional outcome of epilenticular intraocular lens (IOL) implantation vsthe technique of anterior continuous curvilinear capsulorhexis (ACCC), posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and in-the-bag IOL implantation in paediatric cataract surgery.MethodsForty eyes of 33 children with developmental or traumatic cataract, whose mean age was 2-12 years, were randomly divided into two groups A and B. Group A patients underwent epilenticular IOL implantation while in group B patients, ACCC, PCCC with anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and traumatic cataracts (subgroups A2 and B2) were allotted to both the groups. Postoperative visual acuity, opacification of the visual axis, and possible complications were observed and analysed.ResultsFour eyes in subgroup B2 had fibrous or ruptured capsules, and were managed by epilenticular IOL implantation technique. One eye in subgroup B2 developed central posterior capsular opacification and hence required a secondary capsulotomy. All cases in group A maintained a clear visual axis at the last follow-up. Minimal postoperative inflammation was noticed in all groups, which subsided with anti-inflammatory medication. At the last follow-up, all eyes in group A gained visual acuity >/=6/18. Whereas in group B, visual acuity >/=6/18 was obtained in 85.7% cases with the epilenticular IOL implantation technique and in 83.3% cases with ACCC and PCCC with anterior vitrectomy technique.ConclusionEpilenticular IOL implantation offers a safe and effective alternative for management of paediatric cataract. In selected cases of traumatic cataract, it is the preferred treatment modality.Eye advance online publication, 9 June 2006; doi:10.1038/sj.eye.6702451.

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Ophthalmic Res. 2006 Jun 6;38(4):218-245 [Epub ahead of print]
Intravitreal Triamcinolone Acetonide: A Change in a Paradigm.
Jonas JB.
Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht Karls University of Heidelberg, Heidelberg, Germany.

Background: Based on experimental studies and clinical observations by Robert Machemer, Gholam Peyman and others, the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of intraocular diseases. Methods and Results: The most widely injected drug so far has been triamcinolone acetonide for various intraocular neovascular and edematous diseases. Comparing the various diseases with respect to effect and side effects of the treatment, the best response in terms of gain in visual acuity has been achieved for intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. In eyes with various types of noninfectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease, visual acuity increased and the degree of intraocular inflammation decreased. Some studies have suggested that intra- vitreal triamcinolone may be useful as an angiostatic agent in eyes with iris neovascularization and proliferative ischemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration, particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high intraocular pressure leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% in elderly patients within 1 year after injection; postoperative infectious endophthalmitis with a rate of about 1:1,000; noninfectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudoendophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other types of intraocular surgery including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated, if vision redecreases. In nonvitrectomized eyes, the duration of the effect and side effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. It has remained unclear so far, whether and how to remove the solvent agent. In the future, intravitreal triamcinolone may be combined with other antiangiogenic drugs for the treatment of exudative age-related macular degeneration or with neuroprotective drugs for treatment of diabetic retinopathy. Conclusions: Despite an exponentially increasing number of mostly case-series studies, the intravitreal injection of triamcinolone may still be considered an experimental procedure until randomized studies have been presented. Copyright (c) 2006 S. Karger AG, Basel.

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J Cataract Refract Surg. 2006 May;32(5):826-30.
Benefit to patients of bilateral same-day cataract extraction: Randomized clinical study.
Lundstrom M, Albrecht S, Nilsson M, Astrom B.
Department of Ophthalmology, Blekinge Hospital, Karlskrona, Sweden. mats.lundstrom@ltbleking.se

PURPOSE: To compare patients' self-assessed visual function after bilateral surgery performed on the same day with visual function after surgery in 1 eye at a time. SETTING: Department of Ophthalmology, Blekinge Hospital, Karlskrona, Sweden. METHODS: Patients with bilateral cataract were assigned randomly to 2 groups, patients having bilateral surgery on the same day and patients with 2 surgeries done 2 months apart. Both groups were examined before and 2 months and 4 months after surgery. All patients completed the Catquest questionnaire at each ophthalmic examination. RESULTS: Until both eyes were operated on, patients having surgery in 1 eye had significantly more difficulties performing daily life activities (P<.001) and a worse binocular contrast sensitivity (P<.01) than patients who had bilateral surgery on the same day. Four months after surgery of both eyes in both groups, there was no difference in visual function. CONCLUSIONS: Bilateral cataract surgery on the same day allowed rapid rehabilitation of the patient and helped avoid suboptimal visual function in daily life while waiting for second-eye surgery. However, there was no extra long-term benefit of self-assessed visual function compared with cataract surgery in 1 eye at a time.

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J Cataract Refract Surg. 2006 May;32(5):789-94.
Prospective randomized controlled trial of the effect of intracameral vancomycin and gentamicin on macular retinal thickness and visual function following cataract surgery.
Ball JL, Barrett GD.
Sir Charles Gairdner Hospital, Perth, Western Australia. jamesball@doctors.org.uk

PURPOSE: To investigate whether the use of vancomycin (20 microg/mL) and gentamicin (8 microg/mL) in the infusion fluid at the time of cataract surgery increases the incidence of macular thickening as measured with optical coherence tomography (OCT) following phacoemulsification. SETTING: A public teaching hospital in Western Australia. METHODS: Fourty-one patients (50 eyes) with cataracts between 50 and 85 years of age were randomized to receive no antibiotics in the infusion fluid at the time of cataract surgery (control group) or vancomycin (20 microg/mL) and gentamicin (8 microg/mL) in the infusion fluid (antibiotic group). Optical coherence tomography measurements were performed preoperatively and 1 day and 1 and 5 weeks postoperatively. A significant increase in macular thickness (mean of the central 1.0 mm diameter) on OCT was defined as 15 microm or greater. Five weeks postoperatively, the best corrected Snellen acuity and Pelli-Robson contrast sensitivity were measured. RESULTS: Twenty-five percent in the control group and 38% in the antibiotic group had a significant increase in macular thickness measured on OCT 5 weeks postoperatively (P = .34). The mean contrast sensitivity of patients with increased macular thickness on OCT was 1.26, and in those with no change it was 1.43 (P = .001). CONCLUSIONS: The use of intracameral vancomycin (20 microg/mL) and gentamicin (8 microg/mL) at the time of cataract surgery had no significant effect on macular thickness or visual function postoperatively. Overall, 31% of eyes showed an increase of 15 microm or greater in central retinal thickness. These patients had significantly reduced contrast sensitivity.

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J AAPOS. 2006 Feb;10(1):30-6.
Is there a latent period for the surgical treatment of children with dense bilateral congenital cataracts?
Lambert SR, Lynn MJ, Reeves R, Plager DA, Buckley EG, Wilson ME.
Emory Eye Center, Atlanta, Georgia.

Background: It generally is accepted that cataract surgery during the first 6 weeks of life is associated with the best visual outcomes for children with dense unilateral congenital cataracts. The latent period for children with dense bilateral congenital cataracts has not been clearly defined. Methods: The best-corrected visual acuity (BCVA) at 4 to 6 years of age was collected retrospectively on a series of 43 children with dense bilateral congenital cataracts from 4 institutions. All of the children underwent a lensectomy, posterior capsulotomy, and anterior vitrectomy at 36 weeks of age or younger. Results: Cataract surgery was performed at a mean age of 11.5 weeks for the better-seeing eye. BCVA was assessed when the children were a mean of 5.3 years of age. The visual acuities of 26 (60%) were 20/40 or better, 12 (28%) were 20/50 to 20/80, and 5 (12%) were 20/100 or worse. There was a trend for worse BCVA with increasing age at the time of surgery (r = 0.28, P = 0.07). We noted that a BCVA of 20/100 or worse occurred only among eyes undergoing surgery when infants were older than 10 weeks (</=10 weeks: 0/21 = 0% vs. >10 weeks: 5/22 = 23%, P = 0.049). Children with preoperative nystagmus had worse visual outcomes; only 38% of children with preoperative nystagmus achieved a BCVA of 20/40 or better compared with 74% of children without preoperative nystagmus (P = 0.03). Conclusion: Previous reports have proposed that cataract surgery during the first 5 to 8 weeks of life is associated with better visual outcomes in children with dense bilateral congenital cataracts. Our results would suggest that good visual outcomes can be achieved beyond this age, but the incidence of poor visual outcomes increases if cataract surgery is delayed beyond 10 weeks of age. The absence of preoperative nystagmus is a better predictor of a good visual outcome than the age at surgery.

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Klin Monatsbl Augenheilkd. 2006 Feb;223(2):142-146.
[Functional Results after Intraocular Lens Implantation with or without Blue Light Filter: An Intraindividual Comparison.]
[Article in German]
Mayer S, Wirbelauer C, Pham DT.
Klinik fur Augenheilkunde, Vivantes Klinikum Neukolln (Dir.: Prof. D. T. Pham), Berlin.

BACKGROUND: The new generation of intraocular lenses (IOL) with an additional blue light filter has a slight yellowish colour (compared to the IOLs with only a UV filter) due to its different light transmitting properties. This could have an effect on contrast sensitivity and subjective visual perception. PATIENTS AND METHODS: In this intraindividual prospective comparative study including 14 cataract patients without further ocular pathology, a blue light filtering IOL (SN60AT, Alcon) was implanted in one eye and 1 month later a conventional single-piece IOL (SA60AT, Alcon) was fitted into the fellow eye. The visual acuity and the clinical findings were assessed at one day and four weeks post-operatively. Contrast sensitivity was tested under defined mesopic (6 cd/m(2)) and high mesopic (18,8 cd/m(2)) light conditions in the Ginsburg Box using the Functional Acuity Contrast Test (F.A.C.T.). Furthermore, subjective differences in the visual perception of both eyes were noted. RESULTS: The contrast sensitivity testing 1 day and 1 month postoperatively, revealed no statistically significant differences (P > 0,008) between both IOL types for all spatial frequencies (1,5/3/6/12/18 cpd) and light levels. 13 patients (85 %) reported no differences in the colour perception of both eyes, and none had visual disturbances. CONCLUSION: This intraindividual comparison revealed no relevant differences concerning mesopic contrast sensitivity and the subjective visual perception after implantation of one IOL with or without a blue light filter.

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J Fr Ophtalmol. 2006 Feb;29(2):157-63.
[Quality of vision after cataract surgery in patients with prolate aspherical lens.]
[Article in French]
Denoyer A, Roger F, Majzoub S, Pisella PJ.
Service d'Ophtalmologie, Centre Hospitalo-Universitaire Bretonneau, Tours.

PURPOSE: To assess the quality of vision in pseudophakic patients with a prolate aspherical intraocular lens (IOL) compared to patients with a spherical IOL. PATIENTS AND METHODS: Twenty patients undergoing cataract surgery were divided into two groups according to the type of IOL: ten prolate aspherical IOLs (TECNIS Z9000, AMO, USA) and ten spherical IOLs (911 CeeOn Edge, AMO, USA). The integrity of ocular functions was assessed with clinical examination and multifocal electroretinogram. Contrast sensitivities were tested preoperatively in photopic, mesopic, and glared conditions. Postoperative examinations included refractive evaluation before and after mydriasis, pupil diameter, contrast sensitivities, and wavefront aberration analysis. RESULTS: Postoperative best-corrected visual acuity was 0.95 +/- 0.13 for the TECNIS group vs 0.98 +/- 0.11 for the 911 group (p=0.32). Refractive evaluation revealed mydriasis myopic shift in patients with the 911 IOL (- 0.10+/-0.30 D for the TECNIS group vs - 0.68+/-0.21 D for the 911 group, p=0.002). Mesopic contrast sensitivity was improved in the TECNIS group regarding medium and high spatial frequencies (p=0.003 and p=0.002, respectively), whereas photopic and glared contrast sensitivities were equal in both groups. RMS for high-order aberrations was 0.36 +/- 0.07 microm in the TECNIS group vs 0.33 +/- 0.19 microm in the 911 group (p=0.21), and spherical aberration was lower in patients with TECNIS IOL (Z40=0.03+/-0.06 microm vs 0.20+/-0.14 microm, for the TECNIS group and the 911 group, respectively, p=0.029). CONCLUSION: Combining contrast sensitivities and wavefront aberration analysis provided an objective assessment of the quality of vision in pseudophakic patients. Using prolate aspherical IOL could reduce spherical aberration and improve visual acuity, especially in mesopic conditions.

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Eur J Ophthalmol. 2006 Jan-Feb;16(1):33-9.
Accommodative intraocular lenses: Short-term visual results of two different lens types.
Buratto L, Di Meglio G.
Centro Ambrosiano di Microchirurgia Oculare, Milano - Italy.

PURPOSE. To compare the ability of two types of accommodative intraocular lenses (IOLs) to provide uncorrected near and distance visual acuity (VA) after cataract surgery. METHODS. A total of 108 eyes of 75 patients underwent cataract surgery by phacoemulsification and IOL implantation either bilaterally or monocularly with one of two types of accommodative IOLs: the AT-45 lens (69 eyes) or the 1-CU lens (39 eyes). Patients were followed for up to 1 year after cataract surgery. Near VA was measured through the distance correction to obtain the true near vision effect of the accommodating IOL. RESULTS. Uncorrected distance VA of 20/30 or better was achieved by 84.6% of the bilaterally implanted 1-CU patients and 73.6% of the bilaterally implanted AT-45 IOL patients 1 year following surgery. Uncorrected near VA of J1 or better was achieved by 42% of the patients with the bilateral 1-CU implant and 36.8% of the patients with the bilateral AT-45 implant. For J3 or better near acuity, the values were 92.3% for the bilateral 1-CU patients and 84.2% for the bilateral AT-45 patients at 1 year. A total of 54% of the eyes with 1-CU implants underwent a mild myopic shift (<1.0 D), 21% had a mild hyperopic shift, and 45% of the eyes were emmetropic at 1 year. CONCLUSIONS. Both accommodative IOLs provided good near and distance vision postoperatively. The 1-CU IOL appears clinically to provide slightly better uncorrected distance and distance-corrected near VA than the AT-45 lens. (Eur J Ophthalmol 2006; 15: 33-39).

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J Cataract Refract Surg. 2006 Jan;32(1):85-90.
Phacoemulsification and intraocular lens implantation for acute angle closure not treated or previously treated by laser iridotomy.
Imaizumi M, Takaki Y, Yamashita H.
>From the Department of Ophthalmology (Imaizumi, Takaki), Oita University Faculty of Medicine, and the Department of Ophthalmology (Imaizumi, Yamashita), Oita Prefectural Hospital, Oita, Japan.

PURPOSE: To determine the effect of phacoemulsification, aspiration, and intraocular lens (IOL) implantation in eyes with acute angle closure or eyes with prior laser iridotomy for acute angle closure. SETTING: Department of Ophthalmology, Oita Prefectural Hospital, Oita, Japan. METHODS: Eighteen eyes with acute angle closure and 8 eyes with cataracts that had a prior acute angle closure treated by laser iridotomy had phacoemulsification, aspiration, and IOL. A third group that had phacoemulsification, aspiration, and IOL for cataracts only served as controls. The preoperative and postoperative intraocular pressures (IOPs), visual acuities, and number of antiglaucoma medications were compared between these 3 groups. RESULTS: The mean IOPs in the eyes with phacoemulsification, aspiration, and IOL alone and the eyes with prior acute angle closure treated by laser iridotomy were decreased significantly after phacoemulsification, aspiration, and IOL. The mean IOPs in the control group also decreased, but not significantly. There was no significant difference in the postoperative IOP between the 3 groups. The postoperative visual acuities were improved significantly in the 3 groups, and the differences in the final visual acuities were not significant. Postoperatively, the antiglaucoma medication was not needed in the phacoemulsification, aspiration, and IOL-alone group, but medication was necessary in eyes treated previously with laser iridotomy. CONCLUSION: Phacoemulsification with IOL implantation lowered IOP, improved visual acuity, and diminished the need for antiglaucoma medication in eyes with acute angle closure and with a prior acute angle closure treated by laser iridotomy.

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J Cataract Refract Surg. 2006 Jan;32(1):60-66.
Recovery of visual and functional disability following cataract surgery in older people: Sunderland Cataract Study.
Gray CS, Karimova G, Hildreth AJ, Crabtree L, Allen D, O'connell JE.
>From the School of Clinical Medical Sciences (Gray, Crabtree, O'Connell), University of Newcastle upon Tyne, Newcastle upon Tyne, Research and Development Department (Karimova, Hildreth), Sunderland Royal Hospital, and Sunderland Cataract Centre (Allen), Sunderland, United Kingdom.

PURPOSE: To examine changes in visual, psychological, and functional disability in older people waiting for cataract extraction and 6 months after surgery. SETTING: Community-based study in Northeast England. METHODS: Participants were 92 patients (mean age 78.1 years +/- 6.5 [SD], 79% female) with age-related cataract. Questionnaires were administered at time of listing for cataract extraction, 2 weeks preoperatively, and 2 and 6 months after surgery to assess visual symptoms and function, anxiety and depression, perceived health status, cognition, and activities of daily living. RESULTS: Mean waiting time was 265 +/- 64.4 days. Forty-six patients had first-eye surgery, 39 had second-eye surgery, and 7 had sequential-eye surgery (both eyes operated on during follow-up). During the waiting period, there were no significant changes in visual symptoms, cognition, or functional abilities. However, perceived health status, anxiety, and depression improved significantly during this time. For first- and second-eye patients, surgery resulted in significant improvements in all questionnaire scores, except activities of daily living. CONCLUSIONS: Despite waiting 9 months for cataract surgery, patients did not decline in visual symptoms, social functioning, or cognition. In first- and second-eye patients, successful cataract extraction resulted in significant gains in visual function, cognition, and emotional and general well-being. The benefits of cataract surgery in older people extended beyond simple measures of visual acuity.

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J Cataract Refract Surg. 2005 Dec;31(12):2329-33.
Results of cataract extraction after implantable contact lens removal.
Bleckmann H, Keuch RJ.
Augenzentrum DRK Kliniken Westend, Affiliated Hospital of the Humbold University Berlin, Berlin, Germany. prof.dr.h.bleckmann@t-online.de

PURPOSE: To evaluate the visual results following insertion of implantable contact lenses (ICLs) in ametropic eyes and the development of subcapsular opacification with visual loss and to examine the anterior capsule, including the subcapsular tissue alteration, by light microscopy. SETTING: Department of Ophthalmology, Schlosspark-Klinik, affiliated hospital of the Charite Berlin, Humbold University, Berlin, Germany. METHODS: A prospective noncomparative interventional case series of anterior subcapsular cataracts in 9 of 127 (7.1%) patient eyes receiving ICLs to correct myopia and hyperopia was studied. The cataracts were phacoemulsified due to visual loss, and an intraocular lens (IOL) was implanted in the bag. After capsulorhexis, the anterior capsule was withdrawn for light microscopy examination. Visual acuity in each eye was measured before and after ICL implantation and before and after cataract extraction. The age range of cataract patients was 39 to 53 years. RESULTS: Implantable contact lens removal and phacoemulsification with IOL implantation for emmetropia resulted in an increased visual acuity compared to initial vision. Four of 28 hyperopic eyes (14.3%) developed subcapsular central opacification after ICL implantation, whereas 5 of 99 myopic patients (5.1%) developed opacifications. CONCLUSIONS: Patients should be informed prior to ICL implantation, there is a possibility of secondary subcapsular cataract formation and vision reduction. Although the posterior chamber inlay as well as the cataract can be removed and better acuity can be restored, a possible complication due to the ICL implantation cannot be avoided and the accommodation in young patients lost.

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J Cataract Refract Surg. 2005 Dec;31(12):2319-23.
Clinical results of the blue-light filtering AcrySof Natural foldable acrylic intraocular lens.
Marshall J, Cionni RJ, Davison J, Ernest P, Lehmann R, Maxwell WA, Solomon K.
Department of Ophthalmology GKT, the Rayne Institute, St. Thomas' Hospital, London, England. june.spacey@kcl.ac.uk

PURPOSE: To verify the safety and effectiveness of the new AcrySof Natural (Alcon Laboratories, Inc.) blue-light filtering intraocular lens (IOL), which was designed to achieve a light-transmission spectrum similar to that of the natural human crystalline lens. SETTING: Multicenter U.S. clinical trial. METHODS: In a prospective randomized patient-masked multicenter study, 150 patients received the AcrySof Natural IOL and 147 patients received the AcrySof single-piece IOL as a control. Patients with bilateral age-related cataracts who were willing and able to wait at least 30 days between cataract procedures and had verified normal preoperative color vision were eligible for the study. Standardized surgery included a 4.0 to 5.0 mm capsulorhexis and phacoemulsification. All lenses were inserted in the capsular bag, with verification of in-the-bag placement of both haptics. In all bilateral implantation cases, the same model IOL was used in each eye. Postoperatively, contrast sensitivity and color perception were measured up to 180 days and up to 1 year (for visual acuity) after implantation. RESULTS: No statistically significant differences were discovered between the 2 patient groups in visual acuity, contrast sensitivity evaluated under mesopic and photopic conditions, or the number of patients who passed the Farnsworth D-15 color perception test. There were no lens-related adverse events in either group. CONCLUSIONS: The blue-light filtering AcrySof Natural IOL was equivalent to the conventional AcrySof lens in terms of postoperative visual performance. Additional long-term clinical studies should show whether the IOL actually provides the theoretical benefits to retinal health.

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Ophthalmologica. 2005 Nov-Dec;219(6):390-3.
A retrospective analysis of five intra-ocular lenses and the predictive value of six different intra-ocular lens power calculation formulas.
Zuidervaart W, Luyten GP.
Department of Ophthalmology, University Medical Centre Leiden, Leiden, The Netherlands.

Purpose: To evaluate the refractive and visual outcome after implantation of five different lenses and to evaluate the accuracy of six different intra-ocular lens (IOL) power formulas. Setting: Department of Ophthalmology, University Medical Centre Rotterdam, The Netherlands. Methods: In total, 288 eyes had cataract surgery with implantation of a polymethylmethacrylate lens (Centra55B) or a foldable silicone lens (AMO SI40, Staar AA, Silens 5, Pliolens). The pre- and postoperative refraction and visual outcome were analysed for all lenses under study. Six different IOL power formulas have been used to compare the accuracy of the predictive refractive outcome. Results: The Staar Plate Haptic lens was found to have the best uncorrected visual acuity (UCVA) compared to the Centra55B, AMO SI40 and the Pliolens. Based on the A constant given by the company, the Pliolens revealed a significant overcorrection and the Staar Plate Haptic lens an undercorrection. The achieved postoperative refraction minus the intended postoperative refraction caused significant myopia with the Pliolens and hyperopia with the Staar Plate Haptic lens. The SRK-T and the Holladay formulas give the best predictive lens calculations in relation to the axial length. Conclusion: The A constant of all lenses has to be adjusted for our institute. Especially the AMO SI40, the Staar AA lens and the Silens 5 showed a remarkable difference compared to the A constant given by the company. All foldable lenses were comparable in their visual outcome. The significantly better UCVA of the Staar Plate Haptic lens can be explained by the emmetropic outcome of the postoperative refraction. Copyright (c) 2005 S. Karger AG, Basel.

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Ann Pharmacother. 2005 Dec;39(12):2065-71. Epub 2005 Nov 15.
Vitamin e supplementation in Alzheimer's disease, Parkinson's disease, tardive dyskinesia, and cataract: part 2.
Pham DQ, Plakogiannis R.
1 Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY; Internal Medicine Pharmacotherapy Specialist, Kings County Hospital Center, Brooklyn.

OBJECTIVE: To review clinical trials evaluating the safety and efficacy of vitamin E supplementation in Alzheimer's disease, Parkinson's disease, tardive dyskinesia, and cataract. DATA SOURCES: Using the MeSH terms alpha-tocopherol, tocopherols, vitamin E, Parkinson disease, tardive dyskinesia, Alzheimer disease, cataract, and clinical trials, a literature review was conducted to identify peer-reviewed articles in MEDLINE (1966-July 2005). STUDY SELECTION AND DATA EXTRACTION: Published materials including original research, review articles, and meta-analyses were reviewed. Only English-language articles and trials that included vitamin E alone or in combination with other vitamins or minerals were reviewed. Emphasis was placed on prospective, randomized, double-blind, placebo-controlled clinical trials. DATA SYNTHESIS: The clinical studies demonstrated contradicting results regarding the benefits of vitamin E in Parkinson's disease, tardive dyskinesia, and cataract. The study reviewed for Alzheimer's disease seemed to show benefit when vitamin E was used; however, the statistical methods employed are questionable. There is enough evidence from large, well-designed studies to discourage the use of vitamin E in Parkinson's disease, cataract, and Alzheimer's disease. We recommend that vitamin E be considered a treatment option in patients with tardive dyskinesia only if they are newly diagnosed. CONCLUSIONS: We encourage patients to supplement with vitamin E-rich foods. The use of a daily multivitamin, which usually contains 30 IU of alpha-tocopherol, may be beneficial; however, we discourage individual vitamin E supplements that usually contain 400 IU of alpha-tocopherol.

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Bull Soc Belge Ophtalmol. 2005;(297):45-57.
Surgical treatment outcomes of congenital and juvenile cataracts.
Casaer P, Casteels I, Foets B.
Department of Ophthalmology, St Rafael UZ, Leuven, Belgium.

PURPOSE: Evaluation of visual outcome after lens aspiration with or without intraocular lens implantation for isolated congenital and juvenile cataract in children aged 6 years and younger. MATERIAL AND METHODS: Retrospective review of 48 children with isolated congenital and juvenile cataract who were surgically treated between January 1993 and December 2002 and had a minimal follow-up of 12 months. RESULTS: In the group of children with unilateral cataract, 33% (3 out of 9 children) of aphakic children and 45.5% (5 out of 11 children) of pseudophakic children attained a final best corrected visual acuity of 20/200 and 20/60 respectively. In the group of children with bilateral involvement, 35% (6 out of 17 children) of aphakic children have a final best corrected visual acuity of 20/30 and 63.7% (7 out of 11 children) of pseudophakic children have a final best corrected visual acuity of 20/25 or more. CONCLUSION: The results of this study emphasize the need for early surgery and good organisation of postsurgical care in patients with pediatric cataract to optimise visual outcome. Furthermore patients with isolated unilateral congenital cataract surgically treated at an average age of 15 months without primary lens implantation and with variable and low compliance have suboptimal results. The effect of early surgery with primary lens implantation on the long term visual outcome in pediatric cataract needs to be further evaluated.

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Eye. 2005 Nov 4; [Epub ahead of print]
Dexamethasone-netilmicin: a new ophthalmic steroid-antibiotic combination. Efficacy and safety after cataract surgery.
Russo S, Papa V, Bella AD, Favero A, Radulescu C, Gafencu O, Carstocea B, Milazzo G.
1Medical Department, SIFI S.p.A., Aci S.Antonio, Italy.

PurposeThe purpose of this study was to evaluate both efficacy and safety of a new ophthalmic steroid-antibiotic fixed combination containing dexamethasone and netilmicin in the postsurgical management of cataract surgery.MethodsIn total, 223 patients were randomly treated with dexamethasone 1 mg/ml plus netilmicin 3 mg/ml (n=148), or dexamethasone 1 mg/ml plus tobramycin 3 mg/ml (n=75, TOBRADEX((R))) four times in a day for 7+/-1 days starting immediately after surgery. Efficacy (anterior chamber (AC) inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia and tearing) and safety (burning, stinging, blurred vision, intraocular pressure, and visual acuity) were analysed in the operated eye after 1 and 7+/-1 days. A follow-up visit was performed at day 14+/-2. The extent of AC inflammation, measured by slit-lamp according to a standard scoring system, was used as primary efficacy parameter.ResultsAt the primary end point (day 7) both fixed combinations were equally effective in reducing postoperative inflammation. The safety profile of the dexamethasone/netilmicin combination was excellent with no evidence of poor local tolerance or adverse reaction.ConclusionsA new fixed combination of dexamethasone and netilmicin was effective and safe in controlling ocular inflammation after cataract surgery.Eye advance online publication, 4 November 2005; doi:10.1038/sj.eye.6702123.

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Br J Ophthalmol. 2005 Nov;89(11):1420-2.
Non-steroidal anti-inflammatory agents for cystoid macular oedema following cataract surgery: a systematic review.
Sivaprasad S, Bunce C, Wormald R.
Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK.

AIM: To examine the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of cystoid macular oedema (CMO) following cataract surgery. METHODS: Systematic literature review of randomised controlled trials (RCTs) that evaluated the effects of NSAIDs in the treatment of CMO following cataract surgery was done according to the Cochrane Collaboration methodology. RESULTS: Seven trials involving a total of 266 participants were included. Four trials studied the effects of NSAIDs in chronic CMO while the other three trials examined the effect of NSAIDs in acute CMO. Little evidence of effectiveness was found for oral indomethacin and topical fenoprofen for chronic CMO in two small trials. Treatment with topical 0.5% ketorolac for chronic CMO was found to be effective in two trials. Three trials examined the effect of topical NSAIDs on acute CMO. The comparisons among these studies were of a NSAID to placebo, prednisolone or another NSAID. Because of considerable heterogeneity between these study designs, their results were not combined in a meta-analysis. CONCLUSION: A positive effect of topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) on chronic CMO was noted. However, there is not enough evidence to show the effectiveness of NSAIDs in acute CMO following cataract surgery.

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Ophthalmology. 2005 Nov;112(11):1997-2003. Epub 2005 Sep 23.
Outcomes of microincision cataract surgery versus coaxial phacoemulsification.
Alio J, Rodriguez-Prats JL, Galal A, Ramzy M.
Instituto Oftalmologico de Alicante, VISSUM Corp., and Ophthalmology Division, Miguel Hernandez University, Alicante, Spain. jlalio@vissum.com

PURPOSE: To compare outcomes of microincision cataract surgery (MICS) with coaxial phacoemulsification. DESIGN: Prospective randomized consecutive case series. PARTICIPANTS: One hundred eyes of 50 patients with nuclear or corticonuclear cataract (grades 2+ to 4) with Lens Opacities Classification System III. METHODS: One hundred eyes (50 patients) were randomly operated through clear corneal incisions using 2 techniques: coaxial phacoemulsification (50 eyes) and microincision cataract surgery (50 eyes). MAIN OUTCOME MEASURES: Mean phacoemulsification time, total phacoemulsification percent, effective phacoemulsification time (EPT) (calculated by multiplying total phacoemulsification time in seconds by the average power percent used), intraoperative total balanced salt solution (BSS) volume, visual outcome, vectorial astigmatic changes, corneal thickness, endothelial cell count, and anterior chamber flare and cells preoperatively and at 1 day, 1 month, and 3 months. RESULTS: Statistically significant differences were found between MICS and coaxial phacoemulsification regarding mean incision size, mean total phacoemulsification percent, and EPT. There were no significant differences between the techniques regarding the mean percent of endothelial cell loss, anterior chamber cell count and flare, mean phacoemulsification time, pachymetric measures or total BSS volume utilized, or visual outcome. The vectorial astigmatic changes in the MICS group showed a change of < or =0.25 diopters (D) in 35% of the eyes, 0.25 to 0.5 D in 50% of the eyes, and 0.5 to 1.0 D in 15% of the eyes. These changes were induced by the surgery. Vectorial astigmatic changes of >1 D were not observed. In the coaxial phacoemulsification group, vectorial astigmatic changes of <0.25 D were not observed either. Changes of 0.25 to 0.5 D were seen in 20% of the eyes, and changes of 0.5 to 1.0 D were seen in 30%. Fifty percent of the eyes showed changes of >1.0 D. Mean vectorial astigmatic changes were 0.36+/-0.23 D in the MICS group and 1.2+/-0.74 D in the coaxial phacoemulsification group (P<0.001). CONCLUSIONS: Microincision cataract surgery significantly lowered mean phacoemulsification time, mean total phacoemulsification percent, mean EPT, and surgically induced astigmatism when compared with coaxial phacoemulsification.

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Ophthalmology. 2005 Nov;112(11):1992-6. Epub 2005 Sep 23.
Aqueous penetration and biological activity of moxifloxacin 0.5% ophthalmic solution and gatifloxacin 0.3% solution in cataract surgery patients.
Kim DH, Stark WJ, O'Brien TP, Dick JD.
Anterior Segment and Cataract/Refractive Service, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-9238, USA.

PURPOSE: To measure the achievable perioperative aqueous concentration of the commercially available topically administered fourth generation fluoroquinolones, moxifloxacin 0.5% ophthalmic solution, and gatifloxacin 0.3% ophthalmic solution, and to correlate this concentration with the agents' biological efficacy in the aqueous humor of patients undergoing routine cataract surgery. DESIGN: Prospective, randomized, parallel, double-masked, clinical trial. PARTICIPANTS: Fifty patients undergoing cataract extraction. METHODS: Patients (n = 25) were given perioperative topical moxifloxacin 0.5% or topical gatifloxacin 0.3% (n = 25). One drop of antibiotic was administered every 10 minutes for 4 doses beginning 1 hour prior to surgery. Aqueous humor was sampled via paracentesis and antibiotic concentrations were determined using validated high performance liquid chromatography (HPLC) procedures. Dilution analyses were performed to determine the biological efficacy of the agents in the aqueous against Staphylococcus epidermidis, the most common cause of postcataract endophthalmitis. MAIN OUTCOME MEASURES: Aqueous humor antibiotic concentrations were measured using HPLC and microdilution bioassay techniques. Biological activity was measured as minimal inhibitory dilution and minimal bactericidal dilution. RESULTS: Aqueous humor concentrations for moxifloxacin via HPLC analysis were 1.80 (+/-1.21) microg/ml, whereas those for gatifloxacin were 0.48 (+/-0.34) microg/ml. This 3.8-fold difference in aqueous humor antibiotic concentrations was statistically significant (P = 0.00003). Similarly, the biological dilution analysis of the aqueous humor samples showed that moxifloxacin attained an estimated activity of 2.1 microg/ml, whereas the gatifloxacin activity was approximately 0.4 mug/ml, which represented a 4.9-fold difference. CONCLUSIONS: This study demonstrated that after topically administered perioperative antibiotics with cataract surgery, moxifloxacin 0.5% ophthalmic solution achieved a statistically significantly higher concentration in aqueous humor compared with gatifloxacin (P = 0.00003). Results from the broth dilution analysis showed that moxifloxacin 0.5% was biologically more active against S. epidermidis than gatifloxacin 0.3% in aqueous humor after topical application. There were no adverse events reported, and incision wounds healed quickly and as expected.

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Clinics. 2005 Oct;60(5):401-6. Epub 2005 Oct 24.
Second eye cataract surgery: perceptions of a population assisted at a university hospital.
Avakian A, Temporini ER, Kara-Jose N.
Discipline of Ophthalmology, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Brazil. aavakian@uol.com.br

OBJECTIVE: To identify daily life difficulties perceived by patients suffering from senile cataract before and after second eye cataract surgery. METHODS: Longitudinal prospective study with 84 patients consecutively seen within the framework of the Cataract Project, with visual acuity equal to or higher than 20/30 in the pseudophakic eye, and equal to or lower than 20/40 with the best possible optical correction in the cataractous eye. A questionnaire was applied during an interview. RESULTS: Before surgery, 60.7% complained about visual impairment (moderate or marked); after surgery, 92.8% had no difficulty. Routine activities, mobility, and leisure activities were significantly altered after surgery (P =.001). CONCLUSION: According to the patients' perceptions, there was a significant reduction in visual difficulties after second eye cataract surgery.

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J Public Health (Oxf). 2005 Oct 18; [Epub ahead of print]
Comparing outcomes of cataract surgery: challenges and opportunities.
McKee M, Whatling JM, Wilson JL, Vallance-Owen A.
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

BACKGROUND: There is an increasing demand for routine assessment of surgical outcomes. However, for assessments to be valid, it is essential to understand the influence of patient characteristics on outcomes. The VF-14 visual function instrument offers a possible means of monitoring outcomes of cataract surgery. This article examines lessons learned in the course of an attempt to do this. METHODS: One thousand and ninety-eight patients (41 per cent male and 59 per cent female) undergoing cataract extraction in 29 private hospitals within the British United Provident Association (BUPA) chain in the United Kingdom completed the VF-14 before and at 4 months following surgery. Outcome was measured in terms of absolute post-operative score achieved. The demographic factors associated with post-operative VF-14 score were examined using multivariate analysis, adjusting for baseline score. RESULTS: Women undergoing cataract extraction had worse pre-operative visual function than men. Post-operative VF-14 score was stable as the age of the patient increased, until age 85, after which it declined. The reduction in final outcome in older people was explained in part by their worse post-operative scores but also was associated with increasing age independent of pre-operative score. CONCLUSION: First, although many patients undergoing cataract extraction at an advanced age will achieve excellent results, older age does reduce the outcome that can be expected. Consequently, comparisons of performance of units or surgeons undertaking cataract surgery must take account of the age spectrum being treated. It is not enough simply to add a health status measure to an existing administrative database. Further research is needed to understand the reasons for the poorer outcomes at older ages, in particular the role of co-existing eye disease and development of data systems must take account of the additional information required to make appropriate adjustments.

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Acta Ophthalmol Scand. 2005 Oct;83(5):561-6.
Phacoemulsification in trabeculectomized eyes.
Ehrnrooth P, Lehto I, Puska P, Laatikainen L.
Department of Ophthalmology, University of Helsinki, Helsinki, Finland. pia.ehrnrooth@sci.fi

PURPOSE: To evaluate retrospectively risk indicators for cataract surgery and the effect of phacoemulsification on intraocular pressure (IOP) control in eyes that have undergone trabeculectomy. METHODS: We undertook a retrospective analysis of 138 eyes with primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG) in 138 consecutive patients over the age of 40 years undergoing trabeculectomy with no antimetabolites performed by one surgeon. Of the 48 eyes (35%) undergoing a cataract operation during the follow-up period of 2-5 years, 46 were included in this analysis. Their IOP, glaucoma medication and best corrected visual acuity (BCVA) before cataract surgery and at the last follow-up were compared. Risk indicators for cataract surgery were analysed. RESULTS: Cataract operations were performed 5.1-58.1 months (median 14.4 months) after trabeculectomy. The mean length of follow-up after cataract surgery was 25.3 months (SD 12.9, median 24.8 months). Before cataract surgery, the mean IOP was 16.2 mmHg (SD 4.9) and the mean number of topical antiglaucoma medicines 0.8 (SD 1.0). At the most recent visit, mean IOP was 17.3 mmHg (SD 6.4) (p = 0.35), and the mean number of medicines was 1.3 (SD 1.1) (p = 0.0007). Of the 22 eyes in which treatment had been categorized as completely successful (IOP < or = 21 mmHg without other therapy) before cataract surgery, 13 (59%) had remained so. The number of failures (IOP > 21 mmHg, or more than one medication needed or further surgery performed) increased from 14 (30%) before surgery to 28 (61%) afterwards. The proportion of failures in the cataract surgery group was twice that in the no cataract surgery group (61% versus 31%). In a proportional hazards regression, only age (73.9 years [SD 9.4] and 68.1 years [SD 9.8] in patients with and without cataract surgery, respectively) proved to be a significant (p = 0.001) indicator for surgery. CONCLUSION: The results of this retrospective study on consecutive clinical cases of trabeculectomy indicate that cataract progression after trabeculectomy is mainly an age-related process. In more than half the eyes with good preoperative IOP control, this good control was maintained after cataract surgery. On the other hand, in some eyes cataract surgery may compromise IOP control even when surgery avoids the area of the bleb.

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Prog Retin Eye Res. 2005 Sep;24(5):587-611. Epub 2005 Mar 29.
Intravitreal triamcinolone acetonide for treatment of intraocular proliferative, exudative, and neovascular diseases.
Jonas JB, Kreissig I, Degenring R.
Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Germany. jost.jonas@augen.ma.uni-heidelberg.de

Within the last three years, triamcinolone acetonide has increasingly been applied intravitreally as treatment option for various intraocular neovascular edematous and proliferative disorders. The best response in terms of gain in visual acuity after the intravitreal injection of triamcinolone acetonide was found in eyes with intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. Visual acuity increased and degree of intraocular inflammation decreased in eyes with various types of non-infectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischemic retinopathies. Possibly, intravitreal triamcinolone may be helpful as adjunct therapy for exudative age-related macular degeneration, possibly in combination with photodynamic therapy. In eyes with chronic, therapy resistant, ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected, cataractogenesis, postoperative infectious and non-infectious endophthalmitis, and pseudo-endophthalmitis. Intravitreal triamcinolone injection can be combined with other intraocular surgeries including cataract surgery. Cataract surgery performed some months after the injection does not show a markedly elevated rate of complications. If vision increases and eventually decreases again after an intravitreal triamcinolone acetonide injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone depended on the dosage given. Given in a dosage of about 20mg to non-vitrectomized eyes, the duration of the effect and of the side-effects was 6-9 months. Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular edematous and neovascular disorders. One has to take into account the side-effects and the lack of long-term follow-up observations.

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Ophthalmologe. 2005 Aug 24; [Epub ahead of print]
[Cataract extraction including posterior chamber lens implantation into eyes with angle-closure glaucoma.]
[Article in German]
Bleckmann H, Keuch R.
Augenzentrum des DRK-Klinikums Westend, Akademisches Lehrkrankenhaus der Humbold-Universitat, Berlin.

OBJECTIVE: The aim of this study was to compare phacoemulsification in eyes with angle-closure glaucoma to the partner eyes with or without iridectomy or laser iridotomy, respectively.METHODS: Twelve eyes with an elevated intraocular pressure due to an angle closure that were treated by phacoemulsification and IOL implantation were compared with 12 partner eyes with narrow angle and iridectomy or iridotomy without intraocular pressure elevation and cataract extraction. The average follow-up period was 15.7+/-2.1 months.RESULTS: The average intraocular pressure in eyes with angle-closure glaucoma was 54.1+/-14.7 mmHg and in the partner eyes 22.4+/-8.6 mmHg preoperatively. Follow-up pressure was 19.3+/-2.0 mmHg in eyes with angle-closure glaucoma and 18.8+/-1.5 mmHg in the partner eyes.CONCLUSION: Primary cataract extraction including posterior chamber lens implantation into eyes with angle-closure glaucoma reduced intraocular pressure to normal levels, increased visual acuity, and decreased the number of antiglaucomatous drugs. Eyes with angle-closure glaucoma do not respond differently to phacoemulsification and lens implantation compared to eyes with narrow angle without pressure elevation during and after phacoemulsification.

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J Cataract Refract Surg. 2005 Aug;31(8):1549-1556.
Visual outcome of microincision cataract surgery with implantation of an Acri.Smart lens.
Alio JL, Rodriguez-Prats JL, Vianello A, Galal A.
>From the Instituto Oftalmologico de Alicante Vissum Incororation (Alio, Rodriguez-Prats, Vianello, Galal), Refractive Surgery and Cornea Unit, Ophthalmology Department, Miguel Hernandez University, Medical School, Alicante, Spain; Ophthalmological Institute (Vianello), La Sapienza University, Rome, Italy; Research Institute of Ophthalmology (Galal), Cairo, Egypt.

PURPOSE: To evaluate visual and refractive outcome of microincision cataract surgery (MICS) with implantation of an Acri.Smart 48S intraocular lens (IOL) (Acri.Tech) through a sub-1.9 mm incision. SETTING: Vissum/Instituto Oftalmologico de Alicante and Ophthalmology Department, Miguel Hernandez University, Alicante, Spain. METHODS: In this consecutive prospective observational noncomparative clinical trial, 45 eyes were included. Microincision cataract surgery was performed through a 1.9 mm or smaller clear corneal incision using low ultrasound power MICS. The IOL was injected using a hydraulic cartridge and injector. The final size of the clear corneal incision, postoperative uncorrected and best corrected near and distance acuities, lens stability, ease of implantation, rate of posterior capsule opacification (PCO), and complications were reported up to 6 months. RESULTS: The Acri.Smart lens was inserted through mean incision of 1.5 mm +/- 0.3 (SD). The mean uncorrected distance visual acuity improved significantly from 20/100 (0.2 +/- 0.2 decimal value) preoperatively to 20/32 (0.7 +/- 0.3) by the end of 6 months postoperatively (P<.000). The best corrected distance visual acuity improved significantly from 20/50 (0.4 +/- 0.2) preoperatively to 20/25 (0.9 +/- 0.2) after 6 months (P<0.000). The uncorrected near visual acuity at the end of 6 months was 20/32 (0.6 +/- 0.2, P<.000). The mean postoperative spherical equivalent was -1.1 +/- 0.9 diopters (P<.947). The safety index was 2.5 for distance and 1.4 for near. There were no intraoperative or postoperative complications. No eye had a neodymium:YAG laser capsulotomy for PCO or reported undesirable complications at the end of 6 months. CONCLUSIONS: Results show that the Acri.Smart 48S IOL is a safe, effective, and stable lens that could be inserted through sub-1.9 mm incisions. It provided excellent surgical performance, predictability, and some degree of pseudoaccommodation.

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Can J Ophthalmol. 2005 Aug;40(4):454-459.
Secondary intraocular lens implantation of traumatic cataract in open-globe injury.
Chuang LH, Lai CC.

Background: The purpose of this study was to determine the visual outcome and accuracy of biometry in traumatic cataract in open-globe injury. Methods: A clinical retrospective study of 30 consecutive patients treated for ocular penetrating trauma was conducted. Patient demographics, causes of injury, wound categories, timing and procedures of the primary repair, interval of subsequent intraocular lens (IOL) implantation, follow-up, and postoperative complications were recorded. Additionally, binocular biometry was documented. Twenty-six eyes (86.7%) were open-globe injuries occurring in the workplace. All patients received cataract extraction with primary repair of the penetrating wound, 18 eyes (60%) underwent trans pars plana vitrectomy with lensectomy and 12 eyes (40%) underwent lens aspiration or extracapsular cataract extraction. Simultaneously, 16 eyes (53.3%) underwent intraocular foreign body removal. Results: The mean visual improvement after secondary IOL implantation was statistically significant (p = 0.002). Seventeen eyes (56.7%) achieved final best-corrected visual acuity of 20/40 or better. The mean deviation of final refraction and target refraction was &ndash;0.69 +/- 0.56 diopter, and 23 eyes (76.7%) were within 1 diopter based on biometry of the traumatic eye. In 18 eyes (60%), the difference was within 1 diopter according to biometry of the fellow eye. In 5 cases (16.7%), there was no improvement of vision because of central corneal scar, secondary glaucoma, macular pucker, or recurrent retinal detachment. Interpretation: The vision of patients with traumatic cataract in open-globe injury was improved after prompt surgical intervention and subsequent IOL implantation. A minority of patients experienced no change in vision or a deterioration of vision due to irregular astigmatism caused by a corneal wound or variable damage to the posterior segment. Using biometry of the injured eye after primary repair was more accurate than using biometry of the fellow eye to determine the power of the lens for IOL implantation in variable open-globe injury.

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J AAPOS. 2005 Aug;9(4):330-5.
Combined intraocular lens implantation and glaucoma implant (tube shunt) surgery in pediatric patients: a case series.
Tesser R, Hess DB, Freedman SF.
Duke University Eye Center, Durham, North Carolina.

Purpose: We sought to investigate the outcomes of children who underwent simultaneous intraocular lens (IOL) implant and glaucoma implant surgery. Methods: Medical records of all patients who underwent simultaneous IOL implant and glaucoma implant surgery from January 1995 through August 2003 by a single surgeon were reviewed. Criteria for success included intraocular pressure </=22 mm Hg, or judged adequate for glaucoma severity, without vision loss or devastating complication. Results: The study included 9 eyes of 8 children who had a mean age of 7.6 years (range, 1-16) and a mean follow-up time of 21 months (range, 8.5-35 months) after simultaneous IOL (either cataract removal with primary IOL, 2 eyes; or secondary IOL implantation, 7 eyes), and glaucoma implant surgery (6 Baerveldt, 3 Ahmed). The indications for combined surgery fell into 3 basic categories: unilateral aphakia with glaucoma (4/9), anatomical features (such as shallow anterior chamber and/or vitreous in the pupillary plane) making an IOL helpful in positioning the tube away from corneal endothelium and/or vitreous (4/9), and unilateral traumatic cataract (1/9). Mean intraocular pressure for operated eyes was 29 mm Hg (range, 21-44) preoperatively and fell to 17 mm Hg (range, 11-22) at last follow up, P = 0.01. The mean number of glaucoma medications was 3.5 preoperatively (range, 2-5) versus 1.9 (range, 0-4) at last follow-up (p = NS). Complications (n = 5) were varied, only 2 of which required additional surgery. Eighty-nine percent (8/9) of patients met criteria for success at last follow-up. Conclusions: Selected children can do well after combined glaucoma implant and IOL surgery, achieving both satisfactory glaucoma control and stable visual acuity.

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Ophthalmology. 2005 Aug 9; [Epub ahead of print]
Intraocular Lens Implantation after Atopic Cataract Surgery Decreases Incidence of Postoperative Retinal Detachment.
Inoue M, Shinoda K, Ishida S, Uchida A, Kurosaka D, Katsura H, Tsubota K.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

PURPOSE: To investigate the efficacy of intraocular lens (IOL) implantation in reducing the incidence of postoperative retinal detachment after cataract surgery in patients with atopic dermatitis. DESIGN: Retrospective review. PARTICIPANTS: One hundred sixty-nine eyes of 126 patients who underwent cataract surgery for atopic cataract were followed for more than 1 year. None of the eyes previously had a retinal detachment or retinal detachment surgery. METHODS: The eyes were divided into 132 eyes of 95 patients with an IOL implantation (IOL group) and 37 eyes of 31 patients without an IOL implantation (aphakia group). The postoperative visual acuity and incidence of postoperative retinal detachment were compared between the 2 groups. The effects of the location of the causative retinal breaks, intraoperative posterior capsule rupture, and postoperative posterior capsulotomy on the incidence of retinal detachments were evaluated. MAIN OUTCOME MEASURES: The postoperative corrected visual acuity, incidence of postoperative retinal detachment, and influence of intraoperative posterior capsule rupture on the retinal detachment. RESULTS: The final visual acuity was better than or equal to 20/20 in 128 eyes (97.0%) of the IOL group and in 29 eyes (78.4%) of the aphakia group (P = 0.0007). Retinal detachment after an uncomplicated cataract surgery occurred in 3 eyes (2.3%) of the IOL group and in 8 eyes (25.8%) of the aphakia group (P<0.0001, Mantel-Cox). Two of 3 eyes (66.7%) in the IOL group and 1 of 8 eyes (16.7%) in the aphakia group that later developed a retinal detachment had an intraoperative posterior capsule rupture. Posterior capsulotomy by yttrium-aluminum-garnet laser did not seem to alter the incidence of postoperative retinal detachment in either the IOL (2.0%) or the aphakia group (25.0%). CONCLUSIONS: The rate of postoperative retinal detachment in eyes with IOL and no intraoperative posterior capsule rupture seems to be low. Intraocular lens implantation with capsular bag fixation may reduce the incidence of postoperative retinal detachment triggered by lens surgery for atopic cataract.

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Curr Med Res Opin. 2005 Aug;21(8):1291-5.
A clinical comparison of two different prednisolone acetate formulations in patients undergoing cataract surgery.
Gayton JL.
Eyesight Associates, Warner Robins, GA, USA. JLGayton@aol.com

PURPOSE: This study was conducted to evaluate the efficacy of two topical steroid prednisolone preparations (Econopred Plus 1%, prednisolone acetate 1%: EPP; Pred Fortedagger 1%, prednisolone acetate 1%: PF) in reducing postoperative inflammation in cataract patients. METHODS: This was a 4 week, randomized, parallel-group, single-center, active-controlled study. One group of patients received postoperative topical EPP while the other group received postoperative topical PF. Both medications were dosed 4 times per day for 14 days and then BID until the container was empty. Both groups of patients received diclofenac sodium QID for 14 days and hydroxypropyl guar (HP-Guar, Systane) QID for 7 days then PRN (or as directed). The presence of corneal surface keratitis, anterior chamber cells and flare (scales 0-3 for keratitis, 0-5 for cells and 0-4 for flare; 0 = none) was evaluated by slit lamp biomicroscopy. RESULTS: EPP produced significantly lower (P < 0.05) anterior chamber flare scores 14 days following surgery (mean +/- SD: 0.86 +/- 0.53) than PF (1.08 +/- 0.40). Otherwise, there were no differences observed between the 2 treatments with respect to keratitis, anterior chamber flare or cells at postop days 1, 7, or 28. CONCLUSIONS: This comparative trial demonstrated that both formulations of prednisolone acetate 1% have similar efficacy in the treatment of postoperative ophthalmologic inflammation.

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Ophthalmology. 2005 Jul 15; [Epub ahead of print]
Pars Plana Lensectomy and Intraocular Lens Implantation in Pediatric Radiation-Induced Cataracts in Retinoblastoma.
Miller DM, Murray TG, Cicciarelli NL, Capo H, Markoe AM.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida.

OBJECTIVE: To investigate visual outcomes, surgical complications, and tumor recurrence among children with retinoblastoma (RB) undergoing pars plana lensectomy, vitrectomy, and simultaneous intraocular lens insertion for radiation-related cataract secondary to external beam radiotherapy (EBRT). DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records for all patients treated with pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens implantation for radiation-induced cataract after EBRT for RB at a single institution between January 1, 1990, and December 31, 2000, were reviewed. PARTICIPANTS: The study included 16 eyes of 12 children with Reese-Ellsworth stage V RB. MAIN OUTCOME MEASURES: Visual acuity, surgical and postoperative complications, postoperative refraction, and tumor recurrence. RESULTS: The median age at diagnosis of RB was 6 months (range, 1-49 months). All patients received EBRT as primary treatment and experienced radiation-induced cataracts. The median interval from RB diagnosis to cataract surgery was 42 months (range, 28-95 months). Preoperative mean visual acuity was 20/400, with 12 of 16 eyes (75%) having macular tumor involvement. All patients underwent pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens insertion. Vitreous samples were evaluated by cytopathologic examination, and no viable tumor cells were identified in any of the vitreous specimens. Postoperative complications included transient cystoid macular edema in 5 eyes (31%) and iridocyclitis in 3 eyes (19%). The mean follow-up after cataract surgery was 66 months (range, 30-94 months). Final visual acuity was 20/40 or better in 11 of 16 eyes (69%). No late intraocular recurrence, orbital tumors, or metastatic disease was noted in this study. CONCLUSIONS: Pars plana lensectomy, vitrectomy, and simultaneous intraocular lens implantation is an effective means of managing EBRT-induced cataracts in eyes with previously treated RB. There was no evidence of active tumor in eyes undergoing surgery at least 28 months after the diagnosis and commencement of therapy for RB, and no late intraocular, orbital, or metastatic tumors were detected. Visual acuity was limited by the presence of primary macular tumor pathologic features in a subset of patients, but final vision better than 20/400 may be achieved in these eyes.

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BMC Ophthalmol. 2005 Jun 22;5:15.
The combination of intravitreal triamcinolone and phacoemulsification surgery in patients with diabeticfoveal oedema and cataract.
Habib MS, Cannon PS, Steel DH.
Sunderland Eye Infirmary, Queen Alexandra Road, SR2 9HP, UK. Maged.Habib@chs.northy.nhs.uk

BACKGROUND: The management of diabetic patients with refractory macular oedema or patients with no adequate pre-operative view to administer laser treatment provide a challenge to the ophthalmologist. We wished to assess the use, safety and effect of intravitreal triamcinolone injection at the time of cataract surgery in patients with diabetic foveal oedema and sight limiting lens opacities. METHOD: This was a longitudinal non-randomised prospective pilot study in 18 eyes (12 patients). All patients had visually significant lens opacities and either persistent diabetic foveal oedema unresponsive to laser treatment-group A, or foveal oedema with no adequate pre-operative view for laser treatment- group B. The cataract surgery was carried out under full aseptic technique using a self-sealing temporal incision and a foldable acrylic lens. Intravitreal triamcinolone was given infratemporally pars plana at the completion of the cataract surgery. The patients were reviewed at day 5, 2 weeks, 2 months and then every 3 months as required. The Wilcoxin matched-pairs test was used to assess the significance of the improvement in visual acuity at 2 months. RESULTS: Twelve patients with a total of 18 eyes were included in the study. There were 10 patients (15 eyes) in group A and 3 patients (3 eyes) in group B. Preoperatively 16 of the 18 eyes had a visual acuity of 6/24 or worse. Postoperatively 83% of patients had completely dry foveae at 2 weeks. Best-corrected visual acuities at two months review ranged from 6/6 to CF with 9 eyes (50%) achieving 6/12 or better (7 eyes (47%) in group A and 2 eyes (67%) in group B). Three eyes had no recorded improvement in visual acuity, but no eyes had deterioration in acuity. The improvement in visual acuity was significant at p = 0.001. There were no significant sight threatening complications. CONCLUSION: Intravitreal triamcinolone has been shown to lead to an improvement in macular oedema and visual improvement in diabetic patients not undergoing cataract surgery but has not, to our knowledge, been previously used in a study like this one.We suggest that intravitreal injection at the time of cataract surgery could be carried out safely with encouraging visual outcomes in patients with diabetic foveal oedema and cataract.

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Ophthalmology. 2005 May 6; [Epub ahead of print]
Cataract surgery for residual angle closure after peripheral laser iridotomy.
Nonaka A, Kondo T, Kikuchi M, Yamashiro K, Fujihara M, Iwawaki T, Yamamoto K, Kurimoto Y.
Department of Ophthalmology, Kobe City General Hospital, Kobe, Japan.

PURPOSE: To investigate the frequency of residual angle closure after resolution of pupillary blocking by laser peripheral iridotomy and the effects of subsequent cataract surgery to resolve angle closure completely. DESIGN: Retrospective, consecutive, interventional study. PARTICIPANTS: Among 70 eyes treated with laser iridotomy, 13 with residual angle closure were treated with cataract surgery. METHODS: The provocative test of angle closure by prone position in a dark room for 1 hour was performed; increases in tension of >/=8 mmHg, 6 or 7 mmHg, and </=5 mmHg were considered to be positive, suspected positive, and negative, respectively. Configuration of the anterior chamber was examined using ultrasound biomicroscopy (UBM). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), response to the dark room prone position test, and morphologic analysis by UBM were evaluated before and 3 months after cataract surgery. RESULTS: Residual angle closure after iridotomy was seen in 27 (38.6%) of 70 eyes; this was confirmed functionally by the dark room prone position test and morphologically by UBM. Eyes with IOP of >/=20 mmHg or with a glaucomatous visual field defect before iridotomy had a significantly higher incidence of residual angle closure after iridotomy than eyes without these findings (P<0.05). In all the eyes with residual angle closure after iridotomy, the response to the prone position test became negative after cataract surgery, with significant lowering of IOP (P<0.01). CONCLUSIONS: Residual angle closure after iridotomy was common, especially in eyes with primary angle closure and poorly controlled IOP or glaucomatous optic neuropathy. Cataract surgery was effective to resolve completely the residual angle closure after iridotomy and lower IOP.

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Cornea. 2005 May;24(4):406-9.
Preoperative injection of mitomycin C in combined pterygium and cataract surgery.
Avisar R, Bar S, Weinberger D.
Department of Ophthalmology and External Eye Disease Clinic, Rabin Medical Center, Petah Tiqva, Tel Aviv University, Israel. lavisar@bezeqint.net

PURPOSE: To evaluate the safety and efficacy of a preoperative injection of mitomycin C (MMC) in combined pterygium and cataract surgery. METHODS: This was a prospective, nonrandomized, interventional trial. Thirty-nine patients with cataract and pterygium enrolled in a prospective, nonrandomized trial. All patients underwent combined pterygium and cataract surgery. Twenty-seven received a single 0.1-mL injection of 0.15 mg/mL MMC into the pterygium head 4 weeks before surgery and 12 did not. Patients were followed for 12 to 23 months postoperatively. Recurrence of pterygium, side effects, and complications of MMC were recorded. RESULTS: Recurrent pterygium developed in none of the patients treated with MMC preoperatively and in 5 of the nontreated patients. Two patients in the pretreated group had allergic conjunctivitis immediately after MMC injection. No other local eye complications or adverse systemic reactions were recorded. CONCLUSIONS: Preoperative injection of MMC into the head of the pterygium 4 weeks prior to combined pterygium and cataract surgery resulted in no recurrence and no serious complications up to 12 to 23 months of follow-up postoperatively. This procedure may be recommended to save time and cost and to prevent the possible side effects of MMC when administered topically at the time of cataract surgery. Further follow-up and additional studies will be needed to determine the long-term safety and efficacy.

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Graefes Arch Clin Exp Ophthalmol. 2005 Apr;243(4):321-6. Epub 2004 Oct 29.
Correction of pre-existing astigmatism during cataract surgery: comparison between the effects of opposite clear corneal incisions and a single clear corneal incision.
Ben Simon GJ, Desatnik H.
Goldschleger Eye Institute and Department of Ophthalmology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.

BACKGROUND: Opposite clear corneal incisions (OCCIs) have been reported to reduce pre-existing astigmatism (PEA) during cataract surgery. Our goal was to evaluate the effect of OCCIs on correcting PEA in cataract surgery.METHODS: Non-randomized prospective study. Thirty-four patients with PEA of greater than 1.5 diopters (D) underwent clear cornea phacoemulsification cataract extraction with 3.2-mm OCCIs (OCCI group). The control group consisted of 23 successive patients with PEA <1.5 D who underwent cataract extraction without OCCI. Best-corrected visual acuity, keratometry and refraction were recorded for all patients pre-operatively and post-operatively.RESULTS: Using keratometric findings, mean astigmatism correction was 1.3 D (+/-0.9 SD; decreased from 2.6 D pre-operatively to 1.4 D post-operatively) in the OCCI group but only 0.4 D in the control group (P<0.005), 8 months post-operatively. Vector analysis of astigmatism correction showed greater change for OCCI patients (1.8 D vs 1.0 D, P=0.002). Using the Holladay method for calculating surgically induced refractive change (SIRC), the OCCI group showed a higher value of SIRC (-1.6 D vs -0.97 D), but this was not statistically significant. The OCCI patients showed a greater and significant change in refraction spherical equivalent than the controls. No complications related to OCCI or cataract surgery occurred during the follow-up period.CONCLUSIONS: Opposite clear cornea incision seems to be a simple, predictable, safe and effective procedure in reducing pre-existing corneal astigmatism in cataract surgery. It has an enhanced effect in correcting astigmatism compared to a single clear cornea incision when using keratometric findings value but not when using refractive data. Future studies are needed to document the long-term effect of OCCI and to evaluate the correlation between incisions of different size and astigmatism correction.

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Eye. 2005 Apr 22; [Epub ahead of print]
Effect of illumination on visual function after monofocal and multifocal intraocular lens implantation.
Elgohary MA, Beckingsale AB.
[1] 1Ophthalmology Department, Essex County Hospital, Colchester, UK [2] 2University Ophthalmology Hospital, Tanta University Hospitals, Tanta, Egypt.

PURPOSE: To compare best-corrected visual acuity (BCVA) and contrast sensitivity (CS) under different levels of illumination in patients who had monofocal and multifocal intraocular lenses (IOLs) and to establish the effect of different lighting conditions on vision in the two groups of patients. METHODS: We retrospectively reviewed 27 patients who underwent phacoemulsification for age-related cataract and IOL implantation of either monofocal (SI30NB; n=10, 37%) or multifocal (SA40N; n=17, 63%) IOLs. Binocular distance and near BCVA and CS were tested using logMAR and Pelli-Robson charts that were externally illuminated with 20, 200, 400, and 1600 lux, and were compared using repeated-measures analysis of variance. A questionnaire was administered to establish the lighting preference in the two groups and the effect of lighting conditions on their vision. RESULTS: Binocular distance and near BCVA and CS significantly increased with increasing illumination from 20 to 200 lux in the monofocal (mean=0.04 vs -0.07; P=0.006; 0.37 vs 0.26, P=0.002 and 1.47 vs 1.60, P=0.01) as well as in the multifocal group (mean=0.03 vs -0.12, P<0.001; 0.38 vs 0.23, P<0.001 and 1.47 vs 1.61, P=0.002). No significant difference in BCVA or CS was found between the two groups at any of the four illumination levels. Both groups had similar lighting preference, but 43.8% of patients in the multifocal group experienced subjective worsening of their vision in bright outdoor lights. CONCLUSIONS: Distance and near BCVA and CS improve with increasing illumination in patients with monofocal and multifocal IOLs, but remain comparable in the two groups under common levels of indoor illumination. Patients with multifocal IOLs may experience worsening of their vision in bright outdoor lights.Eye advance online publication, 22 April 2005; doi:10.1038/sj.eye.6701820.

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Acta Ophthalmol Scand. 2005 Apr;83(2):176-83.
Clinical outcomes of phacoemulsification cataract surgery in diabetes patients: visual function (VF-14), visual acuity and patient satisfaction.
Mozaffarieh M, Heinzl H, Sacu S, Wedrich A.
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

PURPOSE: To evaluate the visual outcomes (visual acuity [VA] and visual function) after phacoemulsification cataract surgery in patients with diabetic retinopathy (DR), and assess patient satisfaction with final surgical outcome. METHODS: This prospective study comprised 74 eyes of 74 patients with different stages of DR. One surgeon (AW) performed all cataract surgery in a standardized fashion. Patients were assessed using the VF-14 (Visual Function-14) questionnaire. The following groups of patients were compared: those with no apparent retinopathy; those with mild non-proliferative DR (NPDR); those with severe NPDR, and those with proliferative DR (PDR). Visual acuity and visual function questionnaire (VF-14) responses were recorded preoperatively and 3 months postoperatively, during which the non-operated fellow eye showed no progression in retinopathy. RESULTS: Improvements in visual outcomes were significantly higher in groups 1 and 2 compared to groups 3 and 4 (Tukey-Kramer, p < 0.001). Comparisons between groups 1, 2 and 3, 4 showed significant differences in improvements in VA (Tukey-Kramer, p < 0.01), yet no statistically significant differences in functional (VF-14) improvements emerged between these groups. CONCLUSIONS: Patients with more advanced levels of DR showed no functional improvements despite improvements in VA. This emphasizes the relevance of patient education prior to surgery. In particular, it should be explained to patients with more advanced DR that, although surgery may be required, their functional improvement may be limited.

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Zhonghua Yan Ke Za Zhi. 2005 Mar;41(3):200-4.
[Long-term follow-up of visual functions after pediatric cataract extraction and intraocular lens implantation.]
[Article in Chinese]
Lai J, Yao K, Sun ZH, Zhang Z, Yang YH.
Eye Center, Second Hospital of Zhejiang University, Hangzhou 310006, China.

OBJECTIVE: To assess the visual acuity and binocular function of children after pediatric cataract extraction and intraocular lens implantation. METHODS: 47 children with 68 eyes (< 13 years old) were included in the study: 12 children with monolateral traumatic cataract, 14 children with monolateral congenital cataract and 21 children with bilateral congenital cataract. Cataract type, cataract extent, age at surgery and presence of strabismus and nystagmus and the best corrected distant visual acuity (BCDVA) before surgery were recorded and as well. In addition, the best corrected near visual acuity (BCNVA) and bionocular function were followed up for an average of (41.3 +/- 12.3) months. Statistical analysis was used to define factors that correlated with achieving good visual acuity and binocular function. RESULTS: BCDVA and BCNVA were 0.5 or better in 34 eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%). Age at surgery, extent of cataract, absence of strabismus and nystagmus were significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus, good BCDVA were significant for good binocular function. CONCLUSIONS: Good visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lens implantation. Multiple factors correlated with achieving good visual function such as timing of surgery, type and extent of cataract, absence of strabismus and nystagmus etal.

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Arq Bras Oftalmol. 2005 Feb;68(1):29-35. Epub 2005 Mar 30.
Comparison of PMMA, foldable silicone and foldable acrylic hydrophobic intraocular lenses in combined phacoemulsification and trabeculectomy.
Serpa Junior E, Wishart PK.
Departamento de Glaucoma, Hospital Governador Celso Ramos, Florianopolis, SC.

PURPOSE: To compare the postoperative results of phacotrabeculectomy with implantation of PMMA, foldable silicone or foldable hydrofobic acrylic intraocular lens (IOL). SETTING: Glaucoma unit, The Royal Liverpool University Hospital, Liverpool, United Kingdom. METHODS: We studied a total of 124 eyes of three consecutive groups of patients with glaucoma and cataract that underwent phacotrabeculectomy with implantation of a PMMA (30 eyes), a foldable silicone (57 eyes) or a foldable acrylic (37 eyes) IOL. Postoperative Snellen visual acuity and intraocular pressure (IOP), and early and late complications were assessed. All data were analyzed by means of c(2) test, Fisher's exact test, ANOVA/MANOVA tests or a combination whenever appropriate. RESULTS: In all three groups the early and late mean postoperative IOPs were significantly lower than the preoperative ones (p<0.001), with no intergroup differences (p=0.48). The number of eyes with early postoperative hypertension (IOP>25 mmHg) and hypotony (IOP<7 mmHg) was similar in the three groups (p=0.91 and p=0.92 respectively). All groups showed improvement in mean visual acuity (p<0.001), and the differences among the groups were not significant (p=0.79). By 9-12 months after surgery IOPs lower than 22 mmHg without glaucoma medication were found in 76.9% in the PMMA group, 76.6% in the silicone group and in 76.9% in the acrylic group. At the same interval, best visual acuity of 6/12 or better was attained in 80.8%, 83% and 80.8%, in the PMMA, silicone and acrylic groups respectively. The silicone group had significantly more postoperative fibrin reaction into the anterior chamber (p=0.01) and giant cell deposits on the IOL (p<0.0001) than the PMMA and the acrylic groups. The rate of Yag laser posterior capsulotomy was lower with the acrylic IOL (0%) than with the silicone (12.2%) or PMMA (13.3%) IOLs (p=0.08). CONCLUSION: In patients with glaucoma and cataract, phacotrabeculectomy with PMMA, silicone or acrylic IOL was equally effective in lowering the IOP and improving visual acuity. However, incidence of fibrin reaction and lens deposits was higher in those eyes which received a silicone IOL. The PMMA and the acrylic groups did not differ with respect to postoperative complications, but those eyes with an acrylic IOL had a lower rate of posterior capsule opacification.

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Curr Opin Ophthalmol. 2005 Feb;16(1):44-52.
Surgical strategies in patients with cataract and glaucoma.
Verges C, Cazal J, Lavin C.
Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain.

PURPOSE OF REVIEW: This review analyzes the most relevant studies on current surgical strategies to treat glaucoma patients with cataracts. RECENT FINDINGS: No clear evidence has confirmed better results with trabeculectomy alone compared with phacotrabeculectomy. Recent studies have reported successful outcomes combining deep sclerectomy and two-site phacoemulsification. The phacoemulsification cataract extraction will not vary the intraocular pressure of patients with previous deep sclerectomy. Mitomycin C proved to be effective in maintaining lower pressure levels with the combined surgery technique; however, 5-fluorouracil did not show any improvement. Minimally invasive cataract surgery reduces surgical trauma, making it possible to obtain better results with combined surgery and previous glaucoma surgery. SUMMARY: The surgical strategy decision must be customized to every patient. Only filtering surgeries are recommended in glaucoma patients with incipient cataract. Combined surgical procedures are recommended for progressive or advanced glaucoma. Two-site phacotrabeculectomy with mitomycin C achieves better stabilized results; however, combined phacoemulsification with deep sclerectomy or viscocanalostomy achieves similar results with a lower rate of complications. These promising findings need more study to be confirmed.

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Curr Opin Ophthalmol. 2005 Feb